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FRIENDS OF MACOMB COUNTY
VETERANS TREAMENT COURT
GRANT REQUEST

Email any supporting documents separately to John Walus at mazziojoe@gmail.com

Your Name:

Estimated Cost of Grant:

Your Email

Please describe the purpose of the grant request:

Please explain why you are unable to pay the expense:

Please describe what community resources you have obtained or attempted to obtain to help with this expense:

State the name, address, telephone number and contact at the company, entity or person to which any funds would be provided: (Grant monies will be paid directly to the primary provider.)

Date of Request:

By checking YES, I understand that If I fail to complete the 41B VTC Program, I will be responsible for total reimbursement of the entire grant:

Thank you!

We have received your submission.

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